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A Ally Long Epiglottis: a Case Report

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A Ally Long Epiglottis: a Case Report Case Report Unusually long epiglottis: A case report Azhar A Siddiqui 1*, A G Shroff 2 1Professor, Department of Anatomy, Indian Institute of Medical Science and Research, Warudi, Tq. Badnapur, Dist. Jalna 2Dean, MGM Medical College, Aurangabad, Maharashtra, INDIA. Email : [email protected] Abstract The Epiglottis is thin leaf shaped cartilage of larynx attached to other cartilages of larynx, hyoid bone and tongue either directly or by mucosal folds. It is usually longer and higher in children than adults. Usually the epiglottis is not seen on oral examination, as it lies below the level of tongue. However rarely, it may be seen in chil dren if it is unusually long labeled as Visible Epiglottis, High Raising Epiglottis or High Arched Epiglottis, etc... A rare case report of Unusually Long Epiglottis is presented in an adult female, detected accidently during routine oral examination for c ommon cold. The patient was not having any complaints because of this condition. Literature states that this condition is rarely seen in children but very rare in adults. If asymptomatic it should be left alone with assurance to the patient and relatives. It may be treated only if creating obstruction to airway. Keywords: High-rising epiglottis, Long Epiglottis, Visible Epiglottis. *Address for Correspondence: Dr. Azhar A. Siddiqui, Professor, Flat No. 1, Saidham Apartment, Jaisingpura, Near University Gate, Aurangabad – 431001, Maharashtra, INDIA. Email: [email protected] Received Date: 25/04/2015 Revised Date: 04/0 5/2015 Accepted Date: 06/05/2015 Development: The epiglottis devel ops from fusion of Access this article online ventral ends of fourth arch with caudal part of hypobronchial eminence. The fetal anatomy of the human Quick Response Code: Website: epiglottis has not yet been fully described. In one study 1 it www.medpulse.in is stated that a mesenchymal condensation of the epiglottic cartilage ap pears posterior and somewhat superior to the hyoid body at 9 weeks, but at 12 and 15 weeks, the root or inferior part descends to the level of DOI: 08 May 2015 the thyroid cartilage. After 20 weeks, the epiglottis again protrudes superiorly beyond the hyoid body. CASE REPORT INTRODUCTION A young lady of around 25 years came to a private clinic Anatomy : The Epiglottis is thin leaf shaped plate of with the complaints of common cold. On examination of elastic fibrocartilage of larynx. Its upper end is free and oral cavity, the practitioner was surprised to see lower end is attached to the posterior surface of thyroid something behind tongue. It was found to be epiglottis. It cartilages. It is also attached to arytenoid cartilage and was confirmed by depressing ton gue. The mucus hyoid bone aryepiglottic folds and hyoepiglottic membrane of epiglottis and surrounding was normal in ligaments. The free upper part is reflected to the tongue appearance with no signs of inflammation or edema. The by glossoepiglottic folds, one median and two laterals findings were also confirmed by indirect laryngoscopy by with the space between them called valleculla. It is E.N.T. Surgeon. There was no history of snoring, sleep usually longer and higher in children than adults. It apnoea or any other r espiratory blockade anytime in her performs important function of directing fluids and food life so far. Photograph of the patient with mouth widely into pharynx by closing the inlet of larynx. open was taken. The epiglottis is seen clearly in the photograph below. MedPulse – International Medical How to site this article: Azhar A Siddiqui , A G Shroff Unusually long epiglottis: A case report. Journal May 2015; 2(5): 275-276. http://www.medpulse.in (accessed 10 May 2015). MedPulse – International Medical Journal, ISSN: 2348-2516, EISSN: 2348-1897, Volume 2, Issue 5, May 2015 pp 275-276 Figure 1: Unusually long epiglottis DISCUSSION is normal with no disturbances of food or air obstruction, Both structural and functional differences exist between as in the present case. Sometimes foreign sensations may the pediatric and the adult larynx. The size of the internal be felt in throat. In these cases assurance may be given to larynx at birth is approximtaly one third of its adult size. patient and relatives that nothing is wrong with their The larynx grows until puberty, at which time it is fully epiglottis and it’s just an unusual variant. Rarely surgical developed. The thyroid cartilage is closer to the hyoid in intervention may be required. the infant. The fetal larynx is positioned high in the neck, usually at the level of the second and third vertebrae, REFERENCES descending to the fourth vertebra at birth, to the fifth at 1. Yukio Katori a, , , Hiromi Takeuchi b, Jose Francisco Rodríguez-Vázquez c, Hiroya Kitano b, Gen Murakami d, approximately 6 years of age, and to the sixth or seventh e at puberty 1. The higher larynx of the infant is softer, more Tetsuaki Kawase Fetal development of the human epiglottis revisited: Appearance of GFAP-positive easily displaced, and more easily irritated. The epiglottis mesenchymal cells and fibrous connections with other projects into the oropharynnx, and its shape has a laryngeal and lingual structures; Annals of Anatomy - considerable range of variation. The so-called infantile Anatomischer Anzeiger Volume 193, Issue 2, March epiglottis is longer, narrower, and more tubular. The 2011, Pages 149–155 epiglottis is softer and less rigid than in the adult 2. 2. Bruce B. Congenital disorders of the larynx. In: Raghavendran S and Vas L 3 reported a 10-yr-old girl with Cummings CW, Schuller DE, Krause CJ, editors. Paediatric otolaryngology-head and neck surgery, 3rd visible epiglottis, followed this with a study of visible edition. St Louis, Baltimore: Mosby; 1998. epiglottis in 100 consecutive patients, ages 6–10 yr, 3. Raghavendran S, Vas L. The visible epiglottis revisited. presenting for routine preanaesthetic check up. They Anesth Analg. 2000; 91(1):249. [PubMed] found a visible epiglottis in six, i.e. 6%. Petkar N. et al 4 4. Petkar N, Georgalas C, Bhattacharyya A. High-rising reported omega shaped visible epiglottis in 3 year old epiglottis in children: should it cause concern? J Am girl. Ahmed FJ et al 5 reported visible epiglottis in 8 year Board Fam Med. 2007; 20(5):495–496. [PubMed] 5. Ahmed FJ, Shinohara AL, da Silva SMB, Andreo JC, de old girl. Alamri YI 6 reported High Rising epiglottis in 10 7 Castro Rodrigues A. Visible Epiglottis in Children. Int J year old boy. Ezri et al (2007) reported incidence of Clin Pediatr Dent 2014; 7 (3): 223-224. visible epiglottis in 1.18% in adults. The other anomalies 6. Alamri Y, Stringer MD. A high-rising epiglottis: a benign of epiglottis reported in literature are bifid epiglottis with anatomical variant. Clin Anat. 2011; 24(5):652–654. vertical median cleft 8, hypoplastic epiglottis 9, and [PubMed] rudimentary epiglottis 10 . 7. Ezri T, Warters RD, Szmuk P, Sael-Eddin H, Geva D, Katz J, Hagbesg C. The incidence of class ‘zero’ airway. Anesth Analg. 2001; 93(4):1073–1075. [PubMed] CONCLUSION 8. Crelin ES, Development of Upper Respiratory System. The present case shows unusually long epiglottis which Clinical symposium vol. 28 No. 3 (1976). can be easily seen behind the tongue. This anomaly is 9. Benjamin B, Dalton C. Hypoplasia of the epiglottis: case very rarely seen in adults. The only reference found was report and review. Int J Pediatr Otorhinolaryngol 1996; 38: 65–9. 1.18% 6 in adults. Even though it is reported rarely in 2 10. Li SP, Fang TJ, Lee SW, Li HY. A rudimentary epiglottis children, the maximum incidence found was 6% , associated with Pierre Robin sequence. Int J Oral definitely more than adults. It is reported more in females Maxillofac Surg 2006; 35: 668–70 than males. It may be noted that in many times the person Source of Support: None Declared Conflict of Interest: None Declared MedPulse – International Medical Journal, ISSN: 2348-2516, EISSN: 2348-1897, Volume 2, Issue 5, May 2015 Page 276 .
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